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Assessment of growth in stature is an essential part of the pediatric examination. Growth is an important index of physical and mental health and of the quality of the child's psychosocial environment; chronic problems in any of these areas may be reflected in a decreased growth rate which may be a critical clue as to the onset of the condition. We shall consider influences on normal growth, the normal growth pattern, the measurement of growth, and conditions that lead to disorders of growth.

Intrauterine Growth

The growth of a fetus begins with a single fertilized cell and ends with differentiation into more than 200 cell types, length increasing by 5000-fold, surface area by 6 × 106-fold, and weight by 6 × 1012-fold. This all to leads to an approximately 7 lb newborn. Overall, the growth of the fetus is dependent on the availability of adequate oxygen and nutrition delivered by the placenta and is orchestrated by a group of growth factors, all overseen by a basic genetic plan. Genetic factors are more important early in gestation, whereas the maternal environment attains more importance late in gestation.

The classic definition of small-for-gestational age (SGA), although somewhat arbitrary, is a birth weight 2 standard deviations below the mean or below the fifth percentile for birth weight, or birth weight below 2500 g for a term infant in the United States. The term intrauterine growth retardation or intrauterine growth restriction (IUGR) is not synonymous with SGA, because IUGR refers to decreased intrauterine growth velocity noted on ultrasound. Statistics and charts showing various percentiles of weight for gestational age are available to determine which premature infants are SGA and what weights are appropriate for gestational age. About 20% of SGA infants remain short as children and adults, in contrast to appropriate-for-gestational-age premature infants, who are smaller at birth but generally experience catch-up growth in the first 2 years. ...